1. Field of the Invention
The present invention generally relates to the field of insurance claims. More particularly, the present invention relates to a system and method for processing insurance claims using a graphical user interface with structured data collection.
2. Description of the Related Art
Insurance companies have been processing and settling claims associated with bodily injury for a long time. The task of evaluating, analyzing or estimating the amount of damage associated with one or more types of bodily injuries, especially trauma-induced bodily injuries, can be very complex. Complexity in the evaluation process often arises out of the fact that concurrent expertise in legal, medical and insurance fields is often required to arrive at a particular decision involving a bodily injury claim.
Several factors can affect the estimated amount of the claim associated with a bodily injury. Every accident is different and every injury is unique. Arriving at a customized evaluation of a bodily injury claim, which is unique for a specific accident, injury, etc. is desirable. Applying across-the-board standards may tend to result in an inequitable solution for one or more parties involved. External environmental factors, such as the experience level of a claims adjuster, record of accomplishment of the legal professionals, post-injury quality of life for the injured party, etc., all can affect the valuation of a claim.
During the past several years, many insurance companies have been using computer-based and knowledge-based claim-processing systems to process, evaluate, analyze and estimate thousands of claims in a fair and consistent manner. A knowledge-based claim-processing system includes an expert system which utilizes and builds a knowledge base to assist the user in decision making. It may allow the insurance companies to define new rules and/or use previously defined rules, in real-time. The business rules are generally written by industry experts to evaluate legal, medical, insurance conditions before arriving at a valuation of a claim.
There were several drawbacks with the earlier knowledge-based system. For example, the user interface (such as a graphical user interface, or GUI) lacked flexibility and was inefficient. In estimating a claim for bodily injury, the user typically had to enter inputs on a display screen and step through a series of displays or screens in a predefined sequence to complete the data input process. The knowledge-based prior art claim processing system would then utilize the user provided inputs, i.e., collect data from the user to generate a claim report. This reduced the user's flexibility and usability. For example, the user was required to enter the requested/required information for each display, before being permitted to proceed to the next display. In addition, the user interface used in the prior art would not permit the user to easily go back to edit data that was entered in a previous display or to go forward to another display. In order to go back to a desired previous display, the application would automatically exit, re-launch, and then go through all the previous displays in sequence to arrive at the desired previous display.
It is, therefore, desirable to develop a new graphical user interface to improve usability and flexibility of a knowledge-based claims processing system. It is desirable for the GUI to provide the user with a road map of all the steps involved with the data collection process. It is also desirable for the GUI to provide full control to the user to select any display screen to enter required data. Thus, the GUI should be of a flexible design to allow the user to select display screens freely, based on user requirements. Furthermore, it is also desirable for the user to be able to edit inputs which were previously entered on previous display screens.